Towards a national health insurance system in ... - Detlef Schwefel

Towards a national health insurance system in Yemen – Part 1: Background and assessments 11
pay. If everybody in a country pays regularly a small amount of money for getting health care in case
of need, funds will be available to give good health care to all citizens, including the poor and needy.
We talk about a national health insurance system, when various endeavours of a fair financing for
health and health care are brought into a network. This might be the case of Yemen, where there are a
few interesting initiatives, that in the future might be coordinated: community health insurance
schemes like in Taiz, fair and regulated cost-sharing schemes for government health facilities, health
insurance schemes for employees of private and public companies, revolving drug funds.
Table 1
Core components of a health insurance scheme
Main Characteristics of Health Insurance Schemes
1 Setting up the scheme 1
2 Membership 2
3 Financing 3
4 Benefits provided by the insurance scheme 4
5 Risk management 5
6 Services 6
7 Legal issues, constitution _ 7
8 Administration 8
9 Healthcare provision 9
10 Provider payment 10
11 Financial profile 11
12 Statistical profile 12
13 Implications 13
14 Health authorities – role of the state _ 14
15 Plans for the coming years 15
Source: Hohmann 2001
We talk about social health insurance, when – for example – the regular contributions of the members
are according to salaries or income, if small and larger families pay the same contributions, and if the
ill do not have to pay more than the healthy members. Social health insurance makes the protection of
each single citizen from health risks a concern of the whole society. Society is much more than the
ensemble of its members or a great organised market on population level, and the individual’s true
interests are best achieved in and through society. If implemented carefully and adapted to the specific
conditions in Yemen, social health insurance can safeguard solidarity and universal coverage.
Nevertheless, it is a long way to get a national and social health insurance system working. In
Germany it took close to 100 years, and it is important to mention that therefore the classical concept
of social health insurance had to be extended in order to allow for the inclusion of self-employed
farmers: Usually, contributions are shared between employers and employees, but in the case of selfemployed
that does not work. And South Korea can be considered as a kind of world champion
because it took only 12 years to cover the whole population, including the poor, the unemployed and
the self-employed. Everybody has to understand that it will take time, too, in Yemen. But the country
should start as soon as possible.
In Yemen, health insurance is often seen as a synonym of building up hospitals, and the countries
experience with cost-sharing leads many stakeholders to perceive health insurance as an additional
source of income mainly for secondary and tertiary health care. Another systemic problem for
implementing health insurance in Yemen derives from the strong impact of user fees introduced in the
early 1990s under the name of cost-sharing. Direct co-payments amount two thirds of total health